International Adoption

Children who have been adopted from other countries are considered high risk for lead exposure. Learn more about how parents, adoption service providers, and healthcare providers can protect children from lead exposure.

The risk for lead exposure is much higher in many countries from which children are adopted than in the United States (123). Each country sets its own policies on regulations for environmental exposures, and some countries have stronger regulations than others. Children’s exposure to sources of lead varies by country (123). Even within a country, lead exposure may vary by racial/ethnic group or income level.

Children from outside the United States can be exposed to lead from

  • Ceramic or metal dishes or pots used for cooking or eating,
  • Contamination from living with a person who is exposed on the job,
  • Contamination from nearby mining and smelting,
  • Cosmetics,
  • Cottage industries (e.g., breaking up batteries or metal ore),
  • Drinking water from metal pipes or metal storage containers,
  • Food, spices, and candies (from the ingredients or the packaging),
  • Industrial emissions, and
  • Traditional medicines
Additional CDC Resources

Blood Lead Levels in Children – information on testing children for lead exposure.

CDC’s Division of Global Migration and Quarantine (DGMQ) – the Division of Global Migration and Quarantine has statutory responsibility to make and enforce regulations necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the United States.

Intercountry Adoption Health Guidance – information for parents, adoption providers, and clinicians about intercountry adoption.

Recommended Actions Based on Blood Lead Level – summary of recommendations for follow-up and case management of children based on confirmed blood lead levels.

Refugees and Other Newcomer Persons Resettled to the United States –  information about lead exposure among children who are immigrants or refugees resettled in the United States.

Video: ‘Lead Poisoning Prevention among Children who have been Adopted from Other Countries’

Other Federal Resources

Child Welfare Information Gateway: Intercountry Adoption
The Child Welfare Information Gateway is a service of the Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.

U.S. Department of State: Intercountry Adoption
This site provides information and guidance to U.S. citizens seeking information about intercountry adoptions.

U.S. Citizenship and Immigration Services [PDF – 1.2 MB]
This site provides information on intercountry adoptions and the immigration process.

Joint Council on International Children’s Services (JCICS)
JCICS is a nonprofit intercountry adoption organization that works to promote ethical practices in intercountry adoption. This site provides information relevant to intercountry adoption service providers, community-based organizations, parent support groups, and medical clinics.


(1) CDC. Elevated blood lead levels among internationally adopted children – United States, 1998. MMWR. 2000;49(5):97-100.

(2) Geltman PL, Brown MJ, Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics. 2001;108(1):158-162.

(3) Parisa T, Leighton J, Auchincloss AH, Faciano A, Alper H, Paykin A, et al. Immigration and risk of childhood lead poisoning: findings from a case–control study of New York City children. Am J Public Health. 2008;98(1):92-97

(4) CDC. Childhood Lead Poisoning Prevention Program (

(5) Canfield RL, Henderson CR, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 µg per deciliter. N Engl J Med. 2003;348:1517–1526.

(6) Hellerstedt WL, Madsen NJ, Gunnar MR, Grotevant HD, Lee RM, Johnson DE. The international adoption project: population-based surveillance of Minnesota parents who adopted children internationally. Matern Child Health J. 2008;12(2):162-171.

(7) Jenista JA. The immigrant, refugee, or internationally adopted child. Pediatr Rev. 2001;22(12):419-429.

(8) CDC. Recommendations for blood lead screening of Medicaid-eligible children aged 1–5 years: an updated approach to targeting a group at high risk. MMWR. 2009;58(RR09):1-11.